Her passage through the birth canal will be among the most dangerous journeys your baby will ever attempt in her life, says Dr. Nalinda Rodrigo, Consultant Gynaecologist and Obstetrician. For you, the mother-to-be, the event is a truly momentous one. As always, it helps to be prepared for what lies ahead.
Modern labour wards can be friendly places, where the wishes of the parents to be are given weight. Make the most of this by educating yourself about your choices and preparing a birth plan, but be prepared to adapt if the situation changes. In this, the third in our series on pregnancy, Mediscene speaks with Dr. Rodrigo about what you can expect as you progress through the three stages of natural labour.
Labour: Stage One
The contractions rippling through your uterus begin to gain intensity, with smaller gaps between each. Your water might break, including a white, phlegm-like substance and perhaps even a little blood, says Dr. Rodrigo, explaining that this is one of the first indications that true labour has begun. Unless there are excessive amounts of blood, don’t let this worry you, but alert your doctor.
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“A certain percentage of women will not know they’ve gone into labour,” says Dr. Rodrigo, explaining that in such cases of ‘silent labour’ women only realise what’s happening when their water breaks or they’re ready to deliver. In stage one, you can expect to experience one contraction of about 40 to 50 seconds every ten minutes.
During this stage, many mothers find it easier to walk a little and to experiment with different positions, such as leaning, squatting or getting on all fours, to ease their discomfort.
The first stage lasts from the onset of dilation to full dilation of the cervix, he explains. As this is happening, the contractions have begun to nudge the baby downwards, so that he or she has almost reached the end of the birth canal. Positioned for birth with the head first, the baby rides out each contraction. Labour gets faster as it progresses: it usually takes more time to go from being 1cm or 2cm dilated to 5cm or 6cm dilated, than from 5cm or 6cm to 10cm (fully dilated.) Labour: Stage two
More and more Sri Lankan women are choosing to have their husbands stay with them through the birth. The support of one’s spouse might be particularly appreciated through the second stage of labour. It’s hard work – you will be actively pushing the baby out, bearing down and dealing with more intense pain.
The second stage begins when the cervix is fully dilated (10cm) and you feel a very strong urge to push downwards into your pelvis, explains Dr. Rodrigo. Remember to push only when instructed to by the staff in attendance – premature pushing can damage your cervix, inflaming it and making things more difficult for your baby and more painful for you.
Typically, the baby comes out head first, and this is known as crowning. A few more contractions and his or her shoulders and head follow and the baby can be gently drawn out. The umbilical cord is usually clamped and cut at this stage. You can request that your spouse be allowed to do this, says Dr. Rodrigo.
Labour: Stage three
This is the shortest of the three stages. Many doctors now prefer what is known as “active management” of third stage, says Dr. Rodrigo. In essence, after your baby's born, you may be given an injection of a synthetic hormone. It stimulates contractions in the uterus, thereby loosening the placenta and pushing it out. You might be asked to give a push or two to help the process along. The placenta will then be examined thoroughly – any part left inside your body could be the cause for infection or haemorrhage. Proponents of natural birth encourage mothers to attempt this without the hormone. Should you prefer this too, make sure your doctor knows your wishes in advance.
You can explore those afforded by alternative medicine – including acupuncture, aromatherapy and massage. For many mothers, meditation and Lamaze classes help them remain calm throughout birth while simultaneously ensuring their baby has enough oxygen as he or she travels down the birth canal.
Epidural: The most preferred form of pain relief during pregnancy, epidurals numb the nerves that carry pain signals from the birth canal to the brain. You might not be able to push, however, and your doctor might opt for an assisted delivery with forceps or ventouse (a suction cap to help the baby out.)
Pain relief injections: Drugs such as pethidine take about 20 minutes to work, and lasts for between two and four hours. These might leave you feeling woozy and interfere with breast feeding. You could ask for half a dose first to gauge how your body responds.
Gas: When breathed in through the mouthpiece at the start of each contraction, it reduces the sharpness of the pain for most women, but it is only a mild painkiller.
Perineal massage is the gentle stretching and massaging of the skin between the anus and vagina (perineum). It’s intended to prevent perineal tears or the need for an episiotomy (a surgical incision made to enlarge the vagina to ease birth.) Begin 4 -6 weeks before your due date, spending 5-10 minutes daily on it. Some women ask their partners to help. Here is one way to perform it:
1. Wash your hands and make sure your nails are short. Get comfortable.
2. Apply an unscented vegetable oil or lubricant like KY Jelly on your thumbs and around the perineum. Place one or two thumbs (or fingers if you can't reach) about 1 inch (2-3cms) inside your vagina. Press downwards and to the sides at the same time. Gently and firmly keep stretching until you feel a slight burning, tingling or stinging sensation.
3. Hold the pressure steady for about 2 minutes until the area becomes a little numb. As you massage, pull gently outwards on the lower part of the vagina with your thumbs hooked inside.
4. Slowly and gently massage back and forth over the lower half of your vagina. Remember to avoid the urinary opening. You can start with very gentle massage, increasing the pressure as sensitivity is reduced.
A birth plan is your take on how you’d like your labour to be. Ask your doctor for his advice and about what is available to you. Remember though that it’s not set in stone - the plan could change if there is any danger to you or your baby. Here are some of things you might want to include:
1. Who do you want to be there with you?
2. Do you want mobility or do you wish to be confined to a bed? What positions would you like to use?
3. What will you do for pain relief?
4. How do you plan to keep hydrated? (sips of drinks, ice chips, IV)
5. Do you want pain medications, or do you want to avoid them? Do you have preferences for which pain medications you want?
6. Would you like an episiotomy?
7. What would make you more comfortable? Do you want to wear your own clothing or have music playing?
8. What are your preferences for your baby's care? (when to feed, where to sleep)
Time to go home:
For at least two hours after the birth of your baby, doctors will need to keep you under observation to ensure there is no haemorrhage – after all, it remains the no.1 cause of maternal mortality in this country, says Dr. Rodrigo. If there are no complications you could be discharged after a mere 24 hours. If you have had an episiotomy, which is more common in first time mothers, it is essential that you be examined within 10 – 14 days to ensure you have healed fully. If it was not required, your recovery is likely to take approximately a week, though it will take 2 – 6 weeks before your womb can shrink back to its normal size.
Slow progress? Inducing labour:
For some women, the onset of labour is delayed while for some others contractions do appear but then cease. If your doctor assures you that you and your baby are safe, then all you need to do is be patient. However, if you’re 10 days or more past your due date, doctors will often consider kick-starting labour by injecting a hormone that stimulates contractions (usually a synthetic oxytocin) or artificial breaking the waters around your baby in a procedure known as amniotomy. The drawback is these can create very strong contractions that are associated with greater discomfort for would-be mothers.